Current through December 10, 2024
A. Agency providers of Support Coordination for the ID/DD Waiver and/or Targeted Case Management for the IDD Community Support Program are required to provide Support Coordination and/or Targeted Case Management statewide.B. Policies and procedures must outline the infrastructure and administrative support to assure, at a minimum, the following: 1. Access to their assigned Support Coordinator/Targeted Case Manager and/or supervisor Monday through Friday from 8:00 a.m. to 5:00 p.m.;2. Supervision of Support Coordinators/Targeted Case Managers to train and offer support and guidance to locate services and providers to meet the person's support needs, identify health and safety risks, and improve coordination of services;3. Secure and confidential management of Support Coordination/Targeted Case Management records; and4. Quality assurance review of Support Coordination/Targeted Case Management records in Medicaid's Long-Term Services and Supports (LTSS) system by supervisory and/or assigned quality assurance staff to include at least the following: (a) Review of each person's application packet and/or Plan of Services and Supports and required attachments initially, at recertification, and with change request(s) before submission to DMH;(b) Quality assurance review of Support Coordination or Targeted Case Management records to determine records adequately reflect all required components; and(c) Inservice to include, but not limited to, common findings during quality assurance review and DMH clarification and feedback.C. Providers must meet conflict free case management requirements, with a goal to limit conscious or unconscious bias a case manager or agency may have that could persuade or limit a person's choice and independence. Requirements include the following:1. Conflict free case management requires coordination of services separate from delivery of other Home and Community Based Services (HCBS). A provider agency may choose to provide either ID/DD Waiver Support Coordination or IDD Targeted Case Management or both but cannot provide any other IDD service. The only exception will be if the State approves a service (such as Crisis Support) when there are no other willing and qualified providers.2. Provider agency staff cannot have interest in another HCBS provider agency. This includes: (a) Employment by or other financial interest in a provider of other IDD HCBS, or(b) Serving in an unpaid role for a provider of other IDD HCBS, such as a board or committee member, a consultant, or other advisory position(s) which have potential of creating bias to persuade a person's choice of provider.3. A Support Coordinator or Targeted Case Manager or supervisory staff cannot be assigned to a person if: (a) Related by blood or marriage, legally responsible, or a paid caregiver of the person receiving service(s);(b) Financially responsible for the person; or(c) Empowered to make financial or health related decisions on behalf of the person.D. The provider agency must provide adequate staffing and coverage of Support Coordination and/or Targeted Case Management caseloads:1. The maximum caseload is thirty-two (32) Waiver participants for a full-time Support Coordinator. Caseload must be adjusted for part-time positions.2. The maximum caseload is thirty-five (35) Targeted Case Management participants for a full-time Targeted Case Manager. Caseload must be adjusted for part-time positions.3. Policies and procedures must address re-assignment and coverage of positions that are vacant.4. If the agency caseload exceeds requirements of the program, the DMH Division Director of the program must be notified.E. Support Coordination must adhere to the requirements of the Support Coordination Manual.F. Targeted Case Management must adhere to the requirements of the Targeted Case Management Manual.